Around 20,000 children in the UK suffer from rheumatoid arthritis, which often appears out of the blue causing swollen, aching joints.

Unfortunately, many doctors fail to recognise this relatively uncommon condition, termed juvenile idiopathic arthritis (JIA), and undiagnosed children are most likely to be crippled within four to five years of its onset.

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We speak to Peter Prouse, consultant rheumatologist at North Hampshire Hospital, Dr Thomas Stuttaford and Jane Tadman from charity Arthritis Research UK, sponsors of Arthritis Care Awareness Week (May 14th to 18th), about what parents should look out for.

What is rheumatoid arthritis?

There are more than 200 types of arthritis, although the most common two are osteoarthritis and rheumatoid arthritis.

Rheumatoid arthritis is more severe and less common than osteoarthritis, and usually appears in younger people, and affects three times as many women as men.

It involves the body's own immune system, normally our natural defence against illness and infection, attacking and destroying joint tissue, resulting in inflammation and pain. Undiagnosed, this condition can lead to muscle wastage, damage to tissues surrounding joints and problems moving knees, hips, or hands – affecting a child's ability to work normally in adult life.

'What causes JIA isn't known – in some cases it can be a faulty inherited gene. But don't worry if you suffer from rheumatoid arthritis because this does not necessarily mean that you will pass it on to your children,' says Dr Stuttaford.

'If your child is diagnosed with JIA, early treatment is best to prevent the breakdown of bone and cartilage leading to joint damage.'

JIA affects a child's movement, and if left untreated could result in disability.

'Doctors may ask to carry out blood tests and eye tests on your child to confirm their diagnosis.'

What symptoms should parents look out for?

If your child complains of pain, swelling, stiffness and is having problems moving their joints, then you should examine the skin over the painful area.

'Ask does it look pinker and feel warmer to your touch than usual?' advises Dr Stuttaford.

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'If so, take your child to see your GP. Tiredness, fatigue, depression and irritability are other common symptoms.'

If your doctor diagnoses rheumatoid arthritis, he or she will not be able to predict how severely your child will be affected but can prescribe treatment to help. 'One problem is that doctors often miss cases of rheumatoid arthritis in children because in its early stages it can be difficult to spot,' says Dr Peter Prouse.

'In the course of five years, many medical students will only receive two weeks training in rheumatology because it has long been a neglected speciality. 'It's vital that this condition is dealt with as early as possible, as my most disabled young patients are those who were not diagnosed for four or five years.'

Exercise and diet

Trying to remain active is important.

'Though your child's joints may be stiff and painful to move, it's important to encourage exercise to prevent muscle wastage and your GP can advise which are best,' says Jane Tadman. Perhaps try to get out walking twenty minutes every day. A growing child's diet is also important.

How do doctors treat JIA?

Although your doctor will be unable to offer your child a complete cure, treatments to slow down the illness and minimize joint damage can be prescribed.

'Patients are given different treatments depending on severity of JIA – these include physiotherapy, exercises, analgesics (painkillers) and anti-rheumatic drugs like prednisolone, an anti-inflammatory steroid and methotrexate, which suppresses the immune system,' says Dr Stuttaford.

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'Anti-TNFs for severe JIA are powerful, very effective drugs, which have revolutionised treatment, while surgery may be recommended for severe joint damage.'

Remember, many children can lead normal lives once their symptoms are under control, thanks to improvements in medication.

'Sometimes a combination of drugs is given to treat the disease itself as well as the pain and inflammation,' adds Jane Tadman.

'JIA goes into remission in some children, but it may reappear in later life.'

New research in the pipeline

A new clinical trial at Kings College London – supported by Arthritis Research UK – is looking at whether lower doses of anti-TNF drugs are effective, with the aim of reducing side-effects and costs.

The study involves gradually reducing the dosage of anti-TNF's in 99 rheumatoid arthritis patients, who had already been taking anti-TNFs for their condition for some time and their illness appeared well-controlled.

Although these drugs have been approved by NICE, some medical centres are reluctant to prescribe them to patients owing to their high cost.

Professor David Scott, chief investigator explains: 'Weaning people slowly off anti-TNF drugs or even just reducing their dose (drug tapering), could have significant benefits – leading to reduced side-effects and considerable savings, enabling more people to access these expensive drugs.'

ANTI-TNF Drugs

New anti-TNF drugs, available for around a year, work by blocking enzymes involved in joint inflammation in rheumatoid arthritis.

Developed by Arthritis Research UK, the anti-TNFs have been shown to be very effective for JIA, when other types of drugs fail to work.

'Etanercept is most widely used on children with severe JIA and Adalimumab can also be prescribed,' says Jane Tadman.

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'Apart from their cost of around £10,000 per patient a year, the downside of anti-TNFs is that their long term effects are unknown and doctors are unsure if the maintenance dose required to hold the disease in check should be the same as the initial dose.'

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